More Visitors

A few weeks ago life here got a little more interesting for a while, not that it has been boring. One Saturday afternoon 2 vans pulled up to Tenwek filled with 10 Canadians. Now living among Kenyans and Americans is good but I do enjoy interacting with fellow Canadians. There weren't just any Canadian but special ones. Mom and Dad, 3 couples from my church in Taber and an aunt and uncle from Ontario. This was special.

The whole group was here from Saturday to Wednesday morning. They slept at a rustic guesthouse down the hill but meals and life in general happened at my place. We were able to squeeze 11 of us around the table and had many hands to do the dishes. Games of cards were played, discussions were had by candlelight – there was no power and Tenwek was explored.

I enjoyed showing my guests a slice of my life here from a hospital tour, to walks around the area and meeting many of the wonderful people that make life here at Tenwek what it is.

Ladies in skirts heading up to the hospital

The walk to visit a friend for Sunday afternoon tea

They all took off for a day to see a pineapple farm

Lunch in the hospital cafeteria

All 11 of us

Wednesday morning 8 of the visitors left for a safari in the Maasai Mara which gave me a few quieter days with Mom and Dad. I took Mom to work with me and sent Dad to the neighbours to fix a door knob. The 3 of us enjoyed the time to ourselves but it was still busy as I was working during the day and ended up hosting bible study in the evening, but Mom and Dad enjoyed bible study as well. Friday afternoon the 8 came back with stories of lions, cheetahs, and zebras after a wonderful safari. We had one last night at Tenwek before arising early the next morning to go climb Mount Longonot. I had climbed Longonot a year ago and remembered it being alright but could not remember how long it took. The day before left I was getting a nervous wondering if we would have enough time to climb it. I was happy to arrive and see the sign 3km to the summit – OK 6 hours round trip this we can do.  A few were not up for a 6km hike so they stayed back and enjoyed the sun but the rest of us enjoyed the view from the top – looking across to lake Naivasha, down into the crater and across the escarpment. From there it was back to Nairobi. After church on Sunday Aunt J. and I returned to Tenwek and the others took off on their next adventure. Aunt J and I have had a nice quiet week here at Tenwek her helping out here and there and finishing her book and me tying up some loose ends before the next adventure starts. Which is right around the corner

Aunt J. and I are joining the visitors in Zanzibar  for a few days of holiday. After this I say a final good-bye to Mom, Dad and guests and they fly home. The next da, rather than head back to Tenwek, I  will hop on a plane to Cameroon. I am going to Mbingo hospital which is a Christian hospital that Samaritans Purse also works with. They invited me to come out to do some education as they are moving toward opening an ICU. I am looking forward to the time there, but will miss the community and familiarity of Tenwek.

Mom and I at the top of Longonot

The Tenwek I call home is running out of room

So I’m starting this post while taking an extended lunch break, why – it is pouring outside. I thought the rainy season was over but I would be soaked to the bone if I tried to walk back to work right now, even if I had an umbrella as the rain is coming sideways. Yesterday, the rain and wind came together so hard that a large tree limb broke off. I was glad no one was under it and that the staff cleaned it up as soon as the rain slowed. This rain is necessary for the plants to grow and keep the Tenwek I call home green. About a month ago I blogged about the Africa you think I live in (but don’t) so this is a follow up to that post as I am writing about the Tenwek I call home.

Tenwek is in rural Kenya halfway between Nairobi and lake Victoria and is in tea country – this means we drink a lot of tea, always with lots of milk and sugar as well as grow lots of tea. Fields full of tea bushes are a beautiful site. Many of the local people are farmers growing corn, beans, potatoes etc. They also may work at the hospital, a bank or a store. People get around in their own vehicles, walk, take a taxi or bus or hire a motor bike driver to get around. They speak a mixture of kipsigis (local tribal language), Swahili and English.

The misty hills

A tea farm about 30 min from tenwek

The view from the road leading to the hospital

Tenwek however is something different in the midst of Kipsigis land. It is a large hospital that provides care for the area as well as trains Kenyan physicians, from all over Kenya. We have the ability to not only teach medicine but disciple many in their faith. Here are some of the physician groups that we train.

• ·         Clinical Officers (CO’s) – CO’s have their schooling at formal institutions but come out here for 1 year for their clinical internship they spend time in OB, Medicine, Pediatrics and surgery. We have 8 of these at a time
• ·         Medical Officers (MO’s) – MO’s have completed medical school but come to us for their intern year, like the CO’s they spend time learning/working in each of the services OB, Medicine, Pediatrics and surgery. We also have 8 of these at a time.
• ·         Family Practice Residents – After completing their MO intern year Kenyan physician’s can work for a few years before going into residency. We train 2 residents per year in Family practice which is a 3 year program, so that is another 6 people.
• ·         Surgical Residents – Tenwek trains surgical residents as part of PAACS (Pan African Academy of Christian Surgeons) We have 2 per year in general surgery, and we just started an Ortho program which is another 2 per year so we have 14 surgical residents (if the math is confusing one year we took in 4 General surgery residents) and once the ortho residency fill up we will have 20 residents.
• ·         Medical Students – as part of their MO training we have med students come out for a few months this is about 10 at a time
• ·         Others – There are also other visiting African residents that spend time at Tenwek. As Tenwek is one of a few mission hospitals to have an ICU other residents come to learn here for a few months from other training locations in Africa. We also have residents coming to learn ophthalmology. So we probably have 2 of these at a time.

Every one listed here is African and they are all at Tenwek for training if you total up the numbers that is 48 people that we are training, and as the programs get full we will be getting more. Also some of these individuals are married and many  have children. With all this going on we are running out of housing. It is the hospital's responsibility to find housing for all these people and our current housing has run out. There are plans to build a new complex to house these trainees and we would appreciate your help. Would you be willing to make a donation so we can continue to house and therefore continue to train high quality doctors for Kenya and Africa?

Some of the trainees gathering for bible study at Dr W's house. 

World Gospel Mission has an account set up specifically for this project. If you are an American you will get a tax receipt, if you are Canadian unfortunately you will not but I hope that will not prevent you from giving to this important project. To give either follow this link https://www.wgm.org/tenwek-hospital-housing or send a cheque to World Gospel Mission

note: for Tenwek Housing Account #125-35006

Donor Services

World Gospel Mission

PO Box 948

Marion, IN  46952-0948

Thank You.

The proposed building to house 44 people. 

VISITORS

I have now been in Kenya for over a year it has been over a year since I have seen my family but I just had a visit from some great friends. I have known Janelle, Kayla and Nella since 2005 when we all went to NAIT and studied Respiratory Therapy together. Through the years we have remained great friends and are the type of friends who due to work, travel, and just general busyness we may go a while without all being together but when we get together again we pick up right where we left off.

Time here with the ladies was fun. Janelle and Nella had an extra adventure getting here as their flights were delayed and then baggage trouble but I was so glad when they all made it to Tenwek. There was an invasion of Canadians and RT's at the hospital as we were able to work all together for a few days. It was fun to have other RT’s to bounce ideas off of. The extra hands also came in handy one morning as we had a power outage for ~30 min and each RT could take an area ICU, HDU, RR and breathe for the patients by squeezing the bag until the ventilators worked again. It was a crash course in how to use the Servo 900C for Janelle; you will have to ask her how it went.

With the extra RT’s at the hospital we did some additional teaching for the nurses and doctors and were able to sort through the equipment rooms in ICU and HDU. Throwing out old/unusable supplies and making the routinely used supplies easier to find.

Nella organizing,

So many little pieces

No time in Kenya is complete without Chai

Creating some tasty food. 

More Chai

The Canadian RT invasion

A trip to Kenya is not really complete without enjoying the beautiful animals that God has placed here so the 4 of us went on a 2 day safari to Maasai Mara. This was a wonderful time. While there I realized this is probably the first time in a year where I did not feel stressed. I am not saying I am stressed out all the time here but living in a culture that is not your own it is sometimes difficult to completely relax. Times when I have gone away to Nairobi or my travels to visit friends I have always had things to do or not been able to completely relax. To be a tourist in a place where I did not have to worry about food, transport, or what language I was speaking was a wonderful vacation. Never mind the wonderful food we ate and the amazing animals and just beauty of the Mara.

Rather than go into more details I will end here with some pictures of the awesomeness.

How close have you been to a Rhino?

 

Just me and  some Cheetahs 

I love giraffes

God paints a beautiful picture every evening. 

Lovely ladies

A baby Elephant was one of the highlights of the safari

One last beautiful sunset. 

My December

So this past month has been hectic and Christmas snuck up on me. To share what I have been up to here’s what I did each week of December.

Week 1 – Spent time in Lodwar with friends as I posted about previously. Got back to work on Friday left again on Saturday for another wedding.

Week 2 –I spent the weekend in Kericho. Monday morning, after the wedding, I headed to Turi, a boarding school that WGM has their annual Christmas meetings. As the meetings do not pertain to me I spent time supervising the children, getting a sunburn, and dealing with a GI bug that prevented me from enjoying some of the wonderful food at Turi. I got back to Tenwek Wednesday night, and worked Thursday and Friday.

Christmas Concert at Turi

Week 3- Worked Monday to Wednesday and hosted youth conference Thursday and Friday. As there was a Doctors/Nurses strike at all the Government hospitals the hospital was crazy busy,meaning I was the only leader aside from the speaker at the conference with 20 youth. By the end of day one, I was exhausted.  I was a little more prepared for day 2 so it went better. Saturday I was supposed to accompany the same youth to an orphanage for a Christmas visit but my pager went off at 3am and I worked till 8am, so I left the youth in the capable hands of one of the other leaders who had the weekend off from the hospital.

Playing games with the youth

Week 4- I worked Monday morning running home to pack in the afternoon as my new house was ready and I could move in. I dragged suitcases down the sidewalk dumped them out in my new place and go back to refill them. I then took a break to join the other missionaries carolling at the hospital – which is packed as there is still a strike going on. After caroling we enjoyed snacks and fellowship with fellow missionaries. I then recruited the children to help carry my suitcases to my new place – moving is done, now to unpack. Tuesday I worked at the hospital and escaped home every once in a while to unpack and get settled. It was Christmas Eve - when did that happen?  I enjoyed the evening with some of the interns and residents as we all watched a movie. A perfect unwind after a crazy day, or month.  Wednesday – Christmas Day I enjoyed food and fellowship with some fellow missionaries. 

Christmas dinner ready to go.

I was very thankful to be included in their celebrations. Thursday – finally a day off, as boxing day is also a Kenyan holiday – which confuses all the Americans. Anyway, I was able to unpack some more and get settled in my new place which will be home for the next 15 months. Friday was another busy day at work with the ER department literally overflowing with patients, thankfully the strike is over and the other hospitals are returning to work so things should hopefully settle down.

So now it’s the end of December, where did the time go? I now have a few days to get settled into my place before some friends come. I am excited to show them my life here as well as spend some time with them and go on a safari. Life just keeps on going.

Happy New Year.

The Africa you think I live in.

Before coming to Tenwek and since coming I have often heard comments about how hot I must be, or asked about how I live, or how the locals dress. For the most part Tenwek is westernized Kenya and the climate is wonderful. In a few weeks I will follow this post up with one called "the Kenya I call home" but this post is about a trip I have taken to the Africa that due to pictures from National Geographic you have embedded in your minds as the place Annette is living. This is not where I live but a place where I am currently visiting.

Back in February, I met a wonderful couple from England. They were engaged to be married and I spent a lot of time with A as we went to language school. D was around for a few weeks as he recovered from a broken toe. A and D spoke a lot about the place they were coming to Lodwar, Kenya. As they talked a picture kept coming up in my mind of “National Geographic Africa” however, I have learned not to assume anything and to not create false expectations of this place knowing that someday I would come and see it. Finally that time came. A and D got married earlier this year in England but decided to have a celebration of their wedding with the Turkana people. They have worked with one of the local villages asked the village to host a traditional turkana wedding for them. I took a week off from work and traveled north.

I decided to fly from Eldoret (instead of Nairobi) and was able to visit Dr M his wife and family, who finished residency at Tenwek a few months ago. I spent a day with them it was great to reconnect, cuddle their children and see more of Kenya. From there I flew to Lodwar. I landed on a paved airstrip walked down the stairs over to the pile of luggage they were making grabbed my bag and walked out the gate. Now I know “gate” is a term common at airports but by gate I mean the door in a chain link fence. There I met my friends and off we went. It was dark so my first glimpses were limited. I did realize one thing – it was hot, not the muggy humid oppressive heat of the coast. But the dry windy hot that this southern Alberta gal had experienced before. I arrived and met many people both local missionaries and guests for the wedding, together we had a feast to celebrate American thanksgiving. The next morning I got my first look, I was staying at the home of a missionary family who are away who graciously opened up their home to guests who had come for the wedding. I looked out my bedroom window at the pool, (yes they have a pool, that’s a conversation for another day) and saw a goat walking under the palm trees.

In the morning we all piled in the land rover and headed out to see lake turakana. This was about a hour and half a drive on bumpy roads and my first view of the areal called turkana. I saw the goats and sheep which I expected and camels which caught me by surprise. The people live in homes made from sticks with grass/leaves pulled through. People were wearing blankets tied around them and some of the ladies were topless. I decided I have arrived in the National Geographic Africa. We had a wonderful time at the lake, wading (or paddling as the brits call it) and enjoyed a picnic of leftover thanksgiving dinner. When its 38 degrees C. cold potatoes and chicken taste great. We finished up with leftover pumpkin pie. Yum.

Saturday was the wedding so off we headed to the village another long bumpy road but you get used to that out here. We were ushered inside one of the grass homes. It is a great design as the grass lets some of the light and breeze through but you are still shaded so really they were quite comfortable. We sat around the bride got dressed in her goat skins the men came in their outfits,my favourite being the ostrich feather hats. The bull and goat got butchered we danced and jumped ate some meat and went on our way. This is just a summary the day that was long but fun. At one point I even got a short nap in I woke up to a bunch of turkana men singing outside the tent and swinging the cow hide. I was thankful that the hide was not thrown into the house.

I now have a few more days in Turkana visiting with A and D It is great to experience life with them.

Dancing

Resting between dancing, all the men sit on little stools, that they carry around

Enjoying leftover pumpkin pie on the shores of lake turkana

Turkana Beads

The Bride and I, she's wearing goat skin

Camels next to an unfinished home

moving and BiPap

I know my last post was medical and I said my next one would be more about life so I will start by saying I moved this weekend. Since arriving at Tenwek I have been living in the home of one of the long term missionaries who was in the states for a year. She returns this week so it was time to move out. My roommate had left a few days earlier so that left me to pack up the house, most of it was mine anyway. My new home is right next door to my current one, which you think would make moving easy, just a few steps. However there are currently people living in “my” house who will be there for another month. So I have moved to a temporary home. This is the biggest place I have lived in yet and the walk from the kitchen to my bedroom feels long. I was thankfully able to move many of my things from my former place to my future place to store in the bedroom, however, I now have things in storage that I wish I had access to. It’s one ofMurphy's laws that you do not need something until it is placed in storage. So the weekend was spent moving and now that’s mostly done and I have been back to work.

I always find it interesting how things at the hospital go in trends, currently we are on a Bipap trend. Bipap is a way of helping someone breathe without putting a tube in their throat. Before I came it was done infrequently but we keep using it more and more. We have a few “home” style bipap machines that work well for some of our patients but they don’t work well for our patients who need a high percentage of oxygen. For these patients we would have to intubate and place them on the ventilator. However a few weeks ago when we had an elderly, hypoxic, COPD patient who I really did not want to intubate  I tried something different. I hooked the bipap mask up to the Servo 900C ventilator and popped it on the patient. It worked like a charm I was able to set the sensitivity so it would not autotrigger, the alarms were easy to set and that patient did well. Since then I have used the servo 900c for multiple patients as a bipap machine and it has helped save many lives. Earlier this week I had a young man who developed a PE and consolidation after he was in a motor bike accident. This man was fully awake however his oxygen levels were low despite oxygen via non rebreather mask. Rather than intubate him, onto bipap via servo 900c he went for 24 hours and then he was fine.   I am thankful for the machines I have to use and the ability to use them for various purposes.

 

BiPap via Servo 900C

In  closing I ask for prayers for a few patients I intubated a 6 month old (the first time I have intubated a baby) and she is very sick and we are not sure why. Please pray she will recover. We also had a young lady come in the other day after a motor bike accident and her leg had to be amputated, Picture is below, don’t look if you can’t handle gross medical pictures. 

to give reference the tourniquet is between her thigh and where her knee should be

Not What I expected

Before I start I should warn all you non-medical people this is a highly medical post, I'm sorry if it is boring or confusing for you.

  When you do anything for a while it becomes your normal. There are occasional variations in the normal but you have the expected variations that you are prepared for. Working at Tenwek there is a type of patient that I have gotten to know very well – the “poisoning patient” these are individuals who have attempted suicide by ingesting chemicals, often pesticides that they have on hand.

We have 1-2 of these patients a week and the treatment is usually along the lines of gastric lavage, intubation and ventilation if unconscious, atropine for low HR, watching electrolytes and if all goes well in a few days extubate them.  They get them some counseling and they go home. Depending on the poison taken some patients end up dying due to electrolyte or other abnormalities but this is still in my thought process of “this is normal for a poisoning patient”. 

 

So when I got called to help set up a ventilator for a poisoning patient I did not think much of it.  The patient came, I placed him on a ventilator – no problems. A few hours later I got a call from the physician.  The patient now had subcutaneous   emphysema and it was getting worse. My immediate thought was my ventilator did something funny – so I asked the staff to bag the patient and went up the hill to see what was up. The ventilator was working fine – well not fine, it's old, but it was not doing anything that would cause a pneumothorax. However, an x-ray was done and it showed a large left pneumothorax the surgeons came placed the chest tube and things went back to normal. Not sure how he got the pneumo as his ventilating pressures were normal – did he have a pre-existing bleb that popped? After a few more days on the ventilator,a chest tube removal, reinsertion and removal again. The patient was eventually transferred to the ward and I pray that with the help of counseling from our chaplains that he will make a full physical, spiritual, and emotional recovery.

                This patient was not my only abnormal poisoning that week. This time it was a 2am page – we have a poisoning patient and we cannot get him oxygenating well on the vent can you come help? So up the hill I went.  When I arrived I saw the patient settled on the ventilator with Spo2 -80’s. I took a listen and didn't hear any air entry on the left side. So I took a look at his x-ray and saw that his left side was completely whited out. OK,not normal. I didn't think this was in relation to the fact that this man had taken poison. So after fiddling with the vent – high PEEP, low PEEP, high rate, lower rate etc. I finally got to some vent settings that the patient managed to oxygenate with. The next day he went for bronchoscopy and he had a huge mucus plug blocking of his left mainstem bronchus – not normal. The next morning I also try to put together more of the history, he had seized in casualty – secondary to hypoxia? Had this man even taken poison? This patient had questions continually running through my brain. Sadly I never found out the answer, I left to Nairobi for a few days and when I came back I learned he coded and died. I pray that he knew The Lord. 

 Sorry to have this post end on a sad note. My next post will be much less medical and be a little more fun.